Lumbar Pseudarthrosis: Diagnosis and Treatment

Lumbar pseudoarthrosis is one of the most common complications of spine surgery. The prevalence of lumbar pseudarthrosis following instrumented lumbar fusion in adults is highly variable across studies with lower back pain being the most common complaint. Some researches believe that spinal instability is directly responsible for the painful symptoms sometimes associated with pseudarthoses. However, this point has also been debated.Diagnostic work-up of these cases include flexion and extension radiographs and CT scans. MRI can also be helpful to identify any residual or new areas of nerve compression. The most definitive test to identify a pseudoarthosis is an exploration of the fusion. This is performed when there is sufficient clinical and radiographic data to suggest the presence of a non-union. Given the associated morbidities and high financial expense, careful thought must be exercised by the responsible physician in the selection of the appropriate patient population for revision surgery. Prior to attempted salvage of arthrodesis, other causes of persistent low back pain should be ruled out and more conservative measures of treatment should be tried first.The following manuscript provides an in-depth discussion on the clinical signs and symptoms of lumbar pseudoarthoses as well as a plan for the diagnostic work-up and treatment of these patients.